Evidence map›Paper›PMID 33484276›Full record

SynthesisEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2021

Value of repeat CT for nonoperative management of patients with blunt liver and spleen injury: a systematic review.

Khadidja Malloum Boukar, Lynne Moore, Pier-Alexandre Tardif, Kahina Soltana, Natalie Yanchar, John Kortbeek, Howard Champion, Julien Clement

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Observational
  3. Article
  4. Article
  5. Article
  6. Article
  7. Observational
  8. Review
  9. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Khadidja Malloum BoukarDepartment of Social and Preventative Medicine, Université Laval, Québec, QC, Canada. Khadidja.malloumb@gmail.com.
Lynne MooreDepartment of Social and Preventative Medicine, Université Laval, Québec, QC, Canada.
Pier-Alexandre TardifPopulation Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Z-201, 1401, 18e rue, Québec, QC, G1J 1Z4, Canada.
Kahina SoltanaDepartment of Social and Preventative Medicine, Université Laval, Québec, QC, Canada.
Natalie YancharDepartment of Surgery, University of Calgary, Calgary, Canada.
John KortbeekDepartment of Surgery, University of Calgary, Calgary, Canada.
Howard ChampionDepartment of Surgery, University of Health Sciences, Maryland, USA.
Julien ClementDepartment of Surgery, Laval University, Québec, QC, Canada.

Funding

CIHR 353374Fonds de Recherche du Québec - Santé 260238
6 · The paper itself

Abstract

purposeTo evaluate the effectiveness of routine repeat computed tomography (CT) for nonoperative management (NOM) of adults with blunt liver and/or spleen injury.

methodsWe conducted a systematic review of randomized and non-randomized controlled trials (RCTs), quasi-experimental and observational studies of repeat CT in adult patients with blunt abdominal injury. We searched Medline, Embase, Web of Science, and Cochrane Central from their inception to October 2020 using Cochrane guidelines. Primary outcomes were change in clinical management (e.g., emergency surgery, embolization, blood transfusion, clinical surveillance), mortality, and complications. Secondary outcomes were hospital readmission and length of stay.

resultsSearch results yielded 1611 studies of which 28 studies including 2646 patients met our inclusion criteria. The majority reported on liver (n = 9) or spleen injury (n = 16) or both (n = 3). No RCTs were identified. Meta-analyses were not possible because no study performed direct comparisons of study outcomes across intervention groups. Only seven of the twenty-eight studies reported whether repeat CT was routine or prompted by clinical indication. In these 7 studies, among the 254 repeat CT performed, 188 (74%) were routine and 8 (4%) of these led to a change in clinical management. Of the 66 (26%) repeated CT prompted by clinical indication, 31 (47%) led to a change in management. We found no data allowing comparison of any other outcomes across intervention groups.

conclusionRoutine repeat CT without clinical indication is not useful in the management of patients with liver and/or spleen injury. However, effect estimates were imprecise and included studies were of low methodological quality. Given the risks of unnecessary radiation and costs associated with repeat CT, future research should aim to estimate the frequency of such practices and assess practice variation. LEVEL OF EVIDENCE: Systematic reviews and meta-analyses, Level II.

Indexed as

Abdominal InjuriesWounds, NonpenetratingAdultHumansLiverSpleenTomography, X-Ray ComputedAbdominal injuryBluntNonoperative managementRepeat CT

Identifiers

PMID33484276

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.